Abstract
Background: Audiovisual integration is essential for daily functions such as speech comprehension. It
relies on a temporal constraint whereby events from different sensory modalities are perceptually
bound within a limited temporal window, the audiovisual temporal binding window, defining the range
of stimulus onset asynchronies perceived as synchronous. While correlational neuroimaging studies
(fMRI, EEG) have implicated a distributed network in audiovisual integration, the causal neural
underpinnings of the temporal binding window remain largely unknown.
Objective
To identify cortical regions causally supporting audiovisual simultaneity judgment.
Methods
Direct electrical stimulation (DES) was prospectively applied to 62 cortical sites during awake
brain surgery in 39 patients . Patients performed a n audiovisual simultaneity judgment task with
varying stimuli onset asynchronies alongside standard sensory -motor, language, and visuospatia l
tasks. Montreal Neurological Institute coordinates were obtained for all stimulated areas.
Results
DES selectively impaired audiovisual simultaneity judgments while sparing other standard
tasks, in 7 highly focal, right-hemispheric cortical sites (<1 cm²). Three sites were situated around the
intraparietal sulcus, and four near the supplementary motor area. Stimulation of left-hemisphere sites
produced non-selective impairments, also affecting language-related tasks.
Conclusions
These findings pr ovide causal evidence for a right -lateralized frontoparietal network,
involving focal regions near the intraparietal sulcus and supplementary motor area, in audiovisual
temporal integration. Given the established roles of these regions in attentional and d ecisional
processes, this study refines their contribution to the temporal binding window network and
underscores the clinical importance of preserving this network during awake brain surgery.
Keys words:
Awake surgery, Multisensory Integration, Audiovisual, Simultaneity judgment, Direct Electrical
Stimulation, Frontoparietal network, Right-hemispheric lateralization
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I) Introduction
Humans experience a constantly changing environment through multiple sensory channels,
each delivering complementary information that must be integrated to create a unified perception of
the external world, a process known as multisensory integration (MSI). MSI plays a crucial role in many
everyday functions, notably in speech comprehension, where visual cues from lip movements facilitate
the understanding [1,2]. The visual and auditory systems differ in transmission speed: although light
travels faster than sound, auditory signals reach the cortex earlier than visual ones, even when both
stimuli occur simultaneously [3]. Thus, the brain must flexibly integrate them to perceive synchrony
while still distinguishing stimuli from separate events [4]. For auditory and visual stimuli to be
integrated, they must occur within a short temporal interval, the Temporal Binding Window (TBW), so
that they are perceived as synchronous [5]. This requirement is illustrated by the strong discomfort
induced by even minor audio–video delays when watching a movie. To study th e TBW, researchers
frequently use the simultaneity judgement task (SJ).
In the SJ task, a variable stimulus-onset asynchrony (SOA) is introduced between stimuli, and
participants judge whether the stimuli are synchronous or asynchronous [6– 9]. Studies employing SJ
tasks typically estimate the point of subjective simultaneity, defined as the SOA at which simultaneity
reports are maximal. In most studies, the point of subjective simultaneity is shifted toward
visual-leading SOAs (about 20–150 ms depending on the paradigm) indicating that visual signals need
to precede auditory signals to be perceived as simultaneous [6,9–11]. The phenomenon is well
documented in the auditory-visual perception literature [4] and is generally interpreted as reflecting
the brain’s adaptation to natural sensory conditions, in which sounds typically reach the brain earlier
than visual information due to faster auditory neural conduction.
Some studies showed MSI processes could rely on a broad and interconnected network [12].
Crossmodal interactions can be observed at very early stages of sensory processing, including primary
auditory and visual cortices [13]. Anatomical tracing studies have revealed direct projections between
early sensory areas, suggesting that crossmodal communication does not rely exclusively on higher -
order convergence zones [14–17]. Physiological evidence further supports this view, as neuronal
populations in both primary auditory and visual cortices exhibit modulatory responses to inputs from
other modalities [18–20]. Beyond these early interactions, higher -order regions including the
prefrontal and parietal cortices could play a crucial role by exerting top-down modulation to integrate
sensory inputs into a unified percept [21–23]. The superior temporal sulcus (STS) has also emerged as
a hub region for MSI, consistently identified across neuroimaging, electrophysiological, and stimulation
studies [24–27]. A study compared brain activation during an SJ task and an attention -to-orientation
task using fMRI and showed differential activation of a network, mainly in the left hemisphere,
including the left anterior superior temporal gyrus, the left inferior parietal cortex, the left medial
frontal gyrus, and the right operculum [28] . However, a review reported no clear lateralization and
identified a broad brain network responsible for the detectio n of asynchrony , including, in both
hemispheres, the auditory and visual cortices, the dorsal fronto -parietal attention network, the
superior colliculi, the insula, the inferior parietal cortex, and the STS [29]. Consistent with this view,
the neural basis of simultaneity judgment has been shown to rely primarily on a broad fronto-parietal
network, which is also involved in temporal processing and selective attention [30]. Taken together,
these studies converge on the conclusion that the fronto-parietal network, particularly the inferior
parietal cortex, in interaction with temporal and sensory cortices, plays a crucial role in th e TBW. At
the same time, additional structures such as the superior colliculi and insula appear to contribute more
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variably depending on task demands and perceptual context. However, the presence of potential
hemispheric lateralization in these areas remains debated.
In these studies, the methods used (EEG, fMRI) were correlational. However, correlational
approaches alone cannot establish a direct causal relationship between the function being tested and
the brain area involved. The importance of combining three types of approaches, correlational,
lesional, and causal methods, for effective brain mapping has been emphasized [31].
The goal of the present study was to investigate the neural mechanisms underlying the
detection of auditory-visual asynchrony. P articipants performed an SJ task using only auditory -first
pairs to facilitate task performance. We adopted a causal approach with maximal spatial and temporal
resolution, based on the methodology of Baurès et al., employing direct electrical stimulation (DES)
during awake brain surgery [32,33]. Disruptions in simultaneity judgments during localized cortical
stimulation, relative to non -stimulated trials, were interpreted as evidence that the stimulated area
contributed to the perception of AV synchrony.
II) Methods
1. Ethics and participants
The study received ethical approval from a French Comité de Protection des Personnes (CPP),
under authorization number NCT04128306 (RC31/18/0240 - Toulouse University Hospital). A total of
55 patients, including 18 women, all diagnosed with a brain tumo ur, were included during 4 years .
However, 7 patients were excluded from the analysis due to their inability to perform the task during
the preoperative testing , and 9 during their surgery. Therefore, the final sample on which the
presented results are based consists of 39 patients (mean age: 50 ± 17 years , 18–70 years), including
13 women. Exclusion criteria included: patients under 18 years of age, individuals with aphasia or a
neglect syndrome, and those unable to comprehend or perform the required tasks.
2. Simultaneity Judgment (SJ) Task protocol
The SJ task was administered using a Dell laptop equipped with a 1.6 GHz i7 processor and a
13.3-inch display (resolution: 1920 × 1080 pixels; dimensions: 29.5 × 17 cm, horizontal x vertical). The
task was programmed and executed using EventIDE software.
Patients performed a simultaneity judgment task in which they were presented with a n
auditory and a visual stimulus. The auditory stimulus consisted of a pure tone at 2000 Hz and lasting
50 ms, delivered through the computer’s built-in speakers, positioned approximately 0.5 meter from
the patient, with a sound intensity of 90 dB . The visual stimulus was a white circle and was displayed
for 50 ms at the center of a black screen. A variable delay, referred to as the stimulus onset asynchrony
(SOA), was introduced between the onsets of the auditory and visual stimuli. For each trial, patients
were asked to indicate whether they perceived the sound and the visual stimulus as perfectly
synchronous (Figure 1).
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Figure 1: Trial structure of the Simultaneity Judgment (SJ) Task, illustrating AV stimulus
presentation and patient response.
3. SJ task preoperative tests
Patients performed a preoperative session of the task the day before surgery to determine
their individual performance level. The SOA between the auditory and visual stimuli ranged from 0 to
350 ms, with 15 possible SOAs separated by 25 ms each . Each patient completed 4 blocks of 45
randomized trials (1 5 SOA × 3 repetitions), for a total of 180 trials. These p reoperative data were
analyzed using R for each patient . For each patient, the r² and slope of the linear regression curve,
representing the percentage of “asynchronous” responses as a function of the SOA, were extracted.
The mean and 95% confidence interval (CI
95) of these parameters were then calculated across patients.
This curve allowed the identification of individual SOA values corresponding to 10% (SOA 10) and 90%
(SOA90) of “synchronous” responses, which were subsequently used for intraoperative testing.
4. SJ task intraoperative tests: direct electrical stimulation
The main advantage of this brain mapping technique is its accuracy. This stimulation is
expected to transiently deactivate a small cortical area, less than 5 mm × 5 mm [34,35]. Our awake
brain mapping protocol was developed based on 25 years of experience [35] and used successfully
following the methodology described in the studies of Baurès et al. [32,33]. Cortical stimulation was
applied with a bipolar electrode (1 mm contacts) delivering biphasic square -wave pulses of 1 ms
duration in a 50 Hz train, with a maximum train duration of 5 seconds. To avoid primary sensory-motor
responses in the analysis of the data, pre - and postcentral gyrus responses were excluded from this
study.
Depending on tumour localisation and usefulness, each cortical area tested with the SJ task
was also tested with at least another task: a language task (object naming) [35], a line bisection test
assessing visuospatial attention performance [36], or sensorimotor tasks. Because of clinical
constraints, we tested each patient in 1 to 3 areas with the SJ task. During surgery, the exact positive
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5
stimulation areas were identified using neuronavigation (BrainLab) and registered onto the patient -
specific 3D images.
Pre- and intraoperative SJ tasks were similar during operations. Nevertheless, due to the more
constrained surgical context, the number of trials had to be limited. Therefore, each patient was tested
using only the two individually determined SOA values from the preoperative session: SOA10 and SOA90.
For each cortical area tested with direct electrical stimulation (DES), a total of 12 trials were conducted:
6 with the SOA 10 and 6 with the SOA 90. For each trial, the neurosurgeon applied stimulation to the
selected area, and an experimenter initiated the trial approximately 1-3 s after stimulation. A break of
20 s was made between two consecutive trials. Each patient was also tested with “ placebo” trials,
during which no actual stimulation was delivered to control for potential effects related to the surgical
context. Patients unable to complete these placebo trials were excluded from the study.
Post-operative statistical analysis ( detailed in supplementary material 1) of SJ data defined
three possible outcomes:
(1) If the patient’s responses remained consistent with pre-surgery performance (i.e., mostly
“asynchronous” for SOA10 and mostly “synchronous” for SOA90), both with stimulation and
during placebo trials, the area was identified as non-engaged in the SJ task.
(2) If the patient showed altered performances during stimulation trials (e.g., reporting
“synchronous” too often at SOA 10 or “asynchronous” too often at SOA 90), the area was
considered involved in the SJ task. If the stimulation also led to language, motor, or
visuospatial attention interference, we qualified the area as a “SJ nonspecific area, ”
indicating that the synchrony perception was not the only function impaired by the
stimulation.
(3) If stimulation affected only the SJ task without interfering with language, motor, or
visuospatial functions, the area was identified as “SJ specific area ”. However, we cannot
exclude the possibility that this “specific” area may affect other untested functions.
All cortical areas were mapped on 3D cortical surface reconstructions of either the left or right
hemisphere of one individual brain (case 12) included in the PALS (population-average, landmark- and
surface-based) atlas [37], using the Caret software [38] and normalized to MNI space. The MNI
coordinates (X, Y, Z) for each positive stimulation area were recorded (see supplementary material 2
and 3 for coordinates, effect on the SJ task, and potential interference with other tasks).
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III) Results
1. Preoperative results
A linear regression of the percentage of “synchronous” responses as a function of SOA was
then calculated for each patient during preoperative testing (see Figure 2 for an example).
Participants’ regressions had a mean r² = .79, 95% CI = [0.7 6: 0.82]. The mean slope of the
regression lines was –0.28, 95% CI = [–0.30: –0.26]. The SOA values corresponding to the 10% and 90%
points of “synchronous” responses were also calculated, as they would be used during intraoperative
tests. The mean SOA10 was 346 ms, 95% CI = [323: 370], and the mean SOA90 was 102 ms, 95% CI = [93:
112].
Figure 2: Preoperative test results for one representative patient. The blue line shows the linear
regression of the percentage of “synchronous” responses across SOAs , with the shaded grey area
representing the 95% confidence interval (CI95).
2. Intraoperative results
The 62 discrete cortical areas stimulated were classified into three categories (Figure 3):
(1) Non-engaged in the SJ task (white dots), where stimulation did not alter performance on
the SJ task.
(2) SJ-nonspecific areas where stimulation impaired SJ task performance in conjunction w ith
either oculomotor disturbances (green dot) or language disruptions (orange dots).
(3) SJ-specific areas (red dots), where stimulation selectively disrupted performance on the SJ
task without affecting any of the other tested tasks. These positive sites had sharp borders, such that
a slight displacement of the electrode, as little as 5 mm within the same gyrus, abolished the
interference. A substantial degree of inter -individual variability was observed, which is commonly
reported when stimulating non-primary cortices in humans.
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Figure 3: Localization of positive areas on the left and right hemispheres (MNI coordinates – see
detailed tables in supplementary material 2 and 3).
Of the 62 stimulated sites, 50 did not disrupt SJ task performance (white points). These white
points indicate areas not involved in the SJ task , but that may be implicated in other cognitive or
sensorimotor functions. Five stimulation sites were classified as SJ-nonspecific areas, as they induced
disruptions in the SJ task along with impairments in other functions: one site (in green) located in the
left superior frontal sulcus ( patient 29) elicited oculomotor disturbances, and four sites (in orange)
interfered with language processing (all in left hemispheres: pars triangularis (patient 12), superior and
middle temporal gyri (patient 35), and supplementary moto area (patient 29)). Over the 7 SJ-specific
areas (in red), 3 were located in the right supramarginal gyrus (patient 17) and the right intraparietal
sulcus (patients 25 and 27), and 4 were within the right frontal lobe, particularly in the supplementary
motor area (Patients 24 and 33) and the middle frontal gyrus (Patient 26). No stimulation site eliciting
neglect was detected in this series.
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IV) Discussion
The study first supports a right -hemispheric lateralization of the audiovisual synchrony
perception, with critical sites located near the intraparietal sulcus and the supplementary motor area
(in red, Figure 4). We also found that synchrony perception relied on highly localized cortical patches,
characterized by sharp functional borders with adjacent cortex and substantial inter-individual
variability. Finally, impairments of audiovisual synchrony judgments in some left-hemispheric sites that
were also involved in language tasks suggest a shared, downstream processing stage between these
two functions, likely related to attentional control, as proposed in previous work [33].
These findings converge with evidence implicating posterior parietal regio ns in temporal
processing. For instance, transcranial direct current stimulation during an SJ task showed that
modulation of the right posterior parietal cortex alters audiovisual temporal judgments, pointing to a
right-lateralized contribution to the TBW [39]. Consistent with this, Wiener et al. used rTMS and
combined rTMS–EEG and demonstrated that stimulation of the right supramarginal gyrus increased
the perceived duration of visual stimuli, further supporting the idea that this region contributes to
temporal computations relevant for distinguishing synchronous from asynchronous events [40,41].
The supramarginal gyrus site identified in the present DES study lies very close to the coordinates
reported by Wiener et al. (yellow point in Figure 4) [41], and to a right supramarginal region implicated
in temporal reproduction in Bueti et al. (green point in Figure 4) [42], reinforcing the notion that this
inferior parietal region is a key node within the network underlying temporal processing.
Our results also re veal SJ -specific areas within the frontal lobe, particularly in the right
supplementary motor area and the right middle frontal gyrus (in red, Figure 4). This finding is
consistent with the frequent implication of the supplementary motor area in temporal estimation and
timing-specific judgments [42 –44]. These results also agree with findings identifying a vast network
involved in the TBW, including primary visual and auditory areas, the superior temporal sulcus (STS),
and frontal regions such as motor areas and prefrontal cortex, with two-way communication between
these areas [29].
Figure 4: Localization of areas involved in the temporal judgment task projected onto a normalized
brain using BrainNet Viewer based on MNI coordinates. Areas from the present DES study are shown
in red; areas from Baurès et al. (2021, 2023) in light and dark blue; the right supramarginal gyrus area
from Wiener et al. (2010, 2012) in yellow; and from Bueti et al. (2008) in green; and the right
intraparietal sulcus and pre-SMA areas from Skagerlund et al. (2016) in violet.
The literature appears divided regarding a possible specific hemispheric lateralization of
temporal processing . For example, some fMRI studies have emphasized left posterior parietal
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involvement during temporal-order or SJ tasks [45,46], whereas transcranial direct current stimulation
Results
have demonstrated only a role for the right posterior parietal cortex [39]. In a literature review
arguing against hemisphere specialization it was found that no right-sided lateralization was present;
instead, a network involving both hemispheres equally was identified , a pattern also supported by
subsequent research [29,30]. In our study, all SJ-specific sites were localized in the right hemisphere.
The left hemisphere was extensively investigated with 44 stimulated sites (N=26). Five sites produced
stimulation-related impairments in the SJ task, but all were non-specific: one site also elicited motor
effects, and four sites were associated with language errors. These areas may contribute to the SJ task,
but our protocol may not have revealed a specific role. It is also possible that stimulation of these areas
altered attentional processes common to both language and TBW.
fMRI studies have consistently implicated the STS in synchrony perception [47–49], identifying
it as a central hub for multisensory integration involved in simultaneity perception [29] . However, in
our study, the STS was not directly involved in either hemisphere: it was only marginally explored on
the right due to the tumour location, and left -hemisphere stimulation mostly affected nearby
language-related cortices. Methodological differences likely contribute to this discrepancy, as DES
provides causal evidence based on focal, transient disruption. In contrast, most studies implicating the
STS in TBW rely on correlational measures and cannot establish a direct causal link with SJ
performance.
By virtue of its spatial accuracy, DES allows dissociating the cognitive functions supported by
small, neighboring cortical areas, even within highly specific cognitive or language domains . This
“mosaic”, patchy organization is a standard observation in many electrostimulation studies [50–52].
The present study shows that the neural bases of audiovisual synchrony perception involve, with a
certain degree of inter-individual variability, a core of discrete, highly localized cortical sites that may
act as relays within a network initiated in the primary auditory and visual areas.
This organization is similar to findings from awake-surgery studies investigating the “time-to-
contact” process, defined as the remaining time before a moving object reaches a target [32,33], which
was tested in a purely visual condition. Their work similarly supported right-hemispheric lateralization
and revealed a specific involvement of regions surrounding the intraparietal sulcus, closely matching
the parietal areas identified here (light and dark blue points in Figure 4). Although these TTC tasks
differ from the SJ task and were unimodal, both rely on temporal judgments. Therefore, it is plausible
that these regions are primarily engaged in temporal processing rather than in multisensory
integration per se. It is also possible that they participate in processes common to both tasks, such as
attentional and decisional mechanisms mediated by the parieto -frontal [30]. After early sensory
processing, auditory and visual cortices interact and converge onto multisensory hubs such as the
superior temporal sulcus (STS), which has been consistently implicated as a key site for audiovisual
integration and simultaneity perception. From there, frontoparietal regions, including the intraparietal
sulcus and frontal areas, likely intervene at a subsequent stage to modulate the sensory signals via
top-down mechanisms driven by context, attentional demands, and task goals. These higher -order
regions may then feed into decisional and motor circuits, with areas such as the supplementary motor
area contributing to the selection and initiation of the behavioral response in the SJ task.
In line with the A Theory of Magnitude (ATOM) framework [53,54], which proposes that time
and space may rely on partially shared neural substrates, fMRI work by Skagerlund et al. has identified
two regions, in the right intraparietal sulcus and the pre -SMA, (in violet in F igure 4) whose activity
shows common effects across temporal and spatial magnitude dimensions [55]. This convergence
further supports the view that the right parietal and frontal regions highlighted by our DES mapping,
together with the right areas reported by Baurès et al. [32,33] constitute a domain-general magnitude
network that contributes to temporal and spatiotemporal judgments in both TTC and SJ contexts.
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Although DES offers spatial and temporal precision far superior to most other brain mapping
techniques, it is not without limitations. First, DES o nly stimulates cortical surface areas, excluding
deeper brain structures. Moreover, operated patients may exhibit tumo ur-induced cortical
reorganization due to neuroplasticity, meaning that regions involved in the task may differ from those
typically recruited in a healthy brain. In lesion -based approaches, such reorganization can lead to
compensatory activity in regions not originally responsible for the function in question. Given that each
patient presents with a unique tumour location and size, group -level statistical analyses are not
feasible. Finally, given the constraints of the operating room environment, the number of tasks tested
by DES can be rather limited (nevertheless, this is a typical pattern of all brain mapping techniques,
invasive or not) . As a result, regions considered as “task -specific” may, in fact, be engaged in other
functions not assessed intraoperatively. Other brain -mapping techniques, such as transcranial
magnetic stimulation (TMS), which are less precise spatially than DES, could serve as a valuable
complementary method. TMS can be applied to healthy participants, allowing validation of findings
obtained during awake surgery without the same constraints on the number of trials, the stimulated
regions, or clinical priorities. For example, TMS was used to investigate temporal-order judgments and
demonstrated that modulation of the right posterior parietal cortex (rPPC) widened the TBW [56].
Awake brain surgery, which offers unmatched spatial and temporal resolution, enabled us to
causally identify a right parieto-frontal network, encompassing regions near the IPS and SMA, as a key
modulator of the audiovisual temporal binding window. Beyond their theoretical contribution, these
findings have direct clinical implications by underscoring the need to preserve this network during
surgery to avoid postoperative deficits in cognitive functions essential to everyday life.
Acknowledgments
The authors wish to express their sincere gratitude to the Neurosurgery Department of CHU
Purpan for providing access to patients and facilitating the intraoperative recordings. We are also
grateful to the surgical teams for their invaluable collaboration.
Availability of data and materials
Data that supports the findings of this study is available on this link:
https://osf.io/ach2n/?view_only=e8673372d24a4e5891c2d5d38d6ee233
Author contributions
• Conceptualization: Solène Leblond, Robin Baurès , Céline Cappe , Franck-Emmanuel
Roux
• Data curation: Solène Leblond, Robin Baurès, Tutea Atger, Marina Poinsignon
• Formal analysis: Solène Leblond, Robin Baurès
• Investigation: Solène Leblond, Tutea Atger , Marina Poinsignon, Franck-Emmanuel
Roux
• Methodology: Solène Leblond, Robin Baurès, Céline Cappe, Franck-Emmanuel Roux
• Project administration: Solène Leblond, Robin Baurès, Céline Cappe, Franck -
Emmanuel Roux
• Resources: Franck-Emmanuel Roux
• Software: Solène Leblond (experiment code), Solène Leblond & Robin Baurès (R data
analysis scripts)
• Supervision: Robin Baurès, Céline Cappe, Franck-Emmanuel Roux
• Validation: Solène Leblond, Robin Baurès, Céline Cappe, Franck-Emmanuel Roux
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11
• Visualization: Solène Leblond, Robin Baurès, Céline Cappe, Franck-Emmanuel Roux
• Writing – original draft: Solène Leblond
• Writing – review & editing: Solène Leblond, Robin Baurè s, Céline Cappe, Franck -
Emmanuel Roux
Funding
This research did not receive any specific grant from funding agencies in the public,
commercial, or not-for-profit sectors.
Conflicts of interests
The authors declare that they have no conflict of interest.
Declaration of generative AI and AI-assisted technologies in the writing process
Generative AI and AI-assisted technologies have been used in the writing process to improve
the readability and language of the manuscript.
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